4
World
Heolth
•
November-December
1992
''Health
is
wealth''
but
also
wealth
is
health
Andrew
Creese
While
poverty
causes
and
perpetuates
ill-health,
economic
growth
also
entails
a
multitude
of
potential
health
hazards.
H
ealth and economic
development go hand
in
hand.
Whether the focus
is
on
countries
or
people, those with the
highest incomes tend to have the
highest levels
of
health and life
expectancy. Eight
of
the "top ten"
countries
in
terms
of
per capita
income are also
in
the "top ten" in
terms
of
life expectancy: Canada,
Finland, Germany, Japan, Norway,
Sweden, Switzerland, and the USA.
Most
of
these countries are also
in
the
"bottom ten"
in
terms
of
infant
mortality, with rates between five and
seven per 1000 live births (data from:
World development report, 1992, New
York, Oxford University Press).
At the other end
of
the spectrum,
the poorest countries and the poorest
people have the lowest levels
of
health. "Rich country, poor children"
(page 12) shows how much higher are
the risks
of
ill-health for the poor in
one rich country, the USA.
But how exactly does a person's or
a country's level
of
economic
development affect health? Firstly,
it
has to be acknowledged that good
health, like most "goods", costs
money. Those who can afford to
spend more on their health -up to a
point -seem to benefit the most. And
spending on health
is
not just about
medicines and medical attention, but
includes expenditures on building and
maintaining a healthy environment,
with safe streets and roads, controlled
pollution, and safe water. Historical
studies have shown that, as people's
income grows, their nutritional status
improves. They live longer and their
children are more likely to survive to
adulthood. Prosperity allows
communities to improve their physical
environment and hygiene.
But prosperity brings its own risks
to health, as the articles by
Professor Ramalingaswami (page 24)
and Messrs Verhoef & Bos (page 15)
illustrate. Comparisons among
countries show a clear tendency for a
fall
in
the rate at which health
improves, as the levels
of
health and
income increase. Each additional
deutschmark or dollar
of
extra
spending on health buys les
s,
in
terms
of
measurable improvements
in
health
status or life expectancy. One
explanation for this could be that
potential health improvements are
offset by the risks from an unhealthy
life-style, with too little exercise, too
rich a diet, too much alcohol and too
much stress. Another possible
explanation
is
that, once good basic
preventive and curative services are
in
place, the extra cost
of
saving or
prolonging life (particularly where the
